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General NPI Number Information
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NPI Number | 1255603064
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Entity Type | Organization
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Legal Business Name | NZBC URBAN CORPORATION, INC.
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 2300 SEVERN AVE APT N204
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City | METAIRIE
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State | LA
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Zip | 70001-1974
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Country | US
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Telephone | 504-301-3015
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Fax | 318-746-0780
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Provider Business Mailing Address
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Address Line | 2300 SEVERN AVE APT N204
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City | METAIRIE
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State | LA
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Zip | 70001-1974
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Country | US
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Telephone | 504-301-3015
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Fax | 318-746-0780
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Authorized Official
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Title or Position | BOARD CHAIRMAN
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Name | DR. PHILIP H WILLIAMSON SR.
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Credential |
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Telephone | 318-617-0376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 385
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License Number State | LA
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